Orange County NC Website
Browse       Search
DocuSign Envelope ID:C7EABF72-ADAA-4072-B58C-21B9B8A9AF97 <br /> DIXON-2 <br /> CERTIFICATE OF LIABILITY INSURANCE DATE(MWDM-YYVI <br /> 07/08/2019 <br /> THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS <br /> CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br /> BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br /> REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. <br /> IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. <br /> If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on <br /> this certificate does not confer ri hts to the certificate holder in lieu of such endorsements. <br /> PRODUCER 828-648-2632 c Acr Patton,Morgan&Clark <br /> Patton,Morgan&Clark PHONE 828-648-2632 FAX 828-648-2642 <br /> P D Box i 02T AK Na Ert: i AfG xo <br /> Canton,NC 28716 E <br /> Patton,Morgan&Clark <br /> Itl LRER f3I AFFp RINNG COVERAGE <br /> INSURERA:The Travelers CDm antes Inc 25682 <br /> INSURED INSURER H <br /> PiP. on Hughes Goodman LtP INSURERC <br /> As @BVI B�H �2$$02 INSURERO: <br /> INSURER E <br /> LNSU RER F <br /> COVERAGE CERTIFICATE E REVISION NUMBERl <br /> THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br /> INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br /> CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br /> EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br /> INSR TYPE OF INSURANCE ADDL SU8 POLECYNWASER POLICY EFF POLICY"P t UNITS <br /> tTRA X COMNERMAL GENERAL LIABILnY i EACH OCCURRENCE i,000,000 <br /> CLAMS-MADE i x i OCCUR j 830-5E1$3024-COF-19 06101/2019 06/01/2020 [TA AGE TO PANTED 1,000,000 <br /> MED EXP(Any one porsonj 10,000 <br /> PERSONAL&ADV I NJ U RY 1,000,000 <br /> GEN1 AGGREGATE LIM17APPLIES PER: GENERAL AGGREGATE S 2,000,000 <br /> X POLICY EJECT F7 LOG ; PRODUCTS- MA 2,000,000 <br /> 7HER <br /> A ALratuolrlLE LIABELTTY <br /> COMBINED SINGLE LIMIT 1,000,000 <br /> ANY AUTO BA-5E261942-19-CAG 06101/2019 06/0112020 BODILY INJURY Par rw <br /> OWNS❑ SCHEDULED <br /> IA{URRTEEOppS 014LY AUUpTryryO.ppSyyVy�� BO�❑ILY INJURY Per cadenl <br /> X AS]TOS ONLY 'x A4JTOS ONLY PPer agdrtl AMAGE <br /> A X UrIB ELLA LLI6 X OCCUR I EACHOCCURRENCE 16,000,000 <br /> EXCESS UAB CLAIMS-MADE CUP-IJ921907-19-43 06/01/2019 06101/2020 AGGREGATE 15,000,000 <br /> DED X RETENTION 3 <br /> 1000t] <br /> A wORKERs Cpl[PENSA" I hr PER I OTH- <br /> AND EMPLOYERS'LtABILnY <br /> YINUS•6K78682d-1943-G 0610112019.0610112020 1,000,000 <br /> ANY PROPRIETORIPARTNERIE%ECUTVE E.L.EACH ACCI ENT <br /> pprrFICE rEIo R EXCLU0ED7 N IA <br /> `Marldataryin 1,000,0D0 <br /> I! E.L DISEASE-EA EMPLOYEE <br /> ❑ SCRIPTEONes,descrtha under F OPERATI ONS babes .DISEASE•POLICY LIMIT 1,000,000 <br /> DESCRIPTION OF OPERATIONS I LOCATION SI VEHICLES [ACORD Sfl1,Additlonnl Rsrrtarb Schad We.may Ca attached if momzpaca Ia m,,Zuiredy <br /> CERTIFICATE HOLDER C 7 <br /> ORANGEC <br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br /> THE EXPIRATION DATE THEREOF, NOTICE WFLL BE DELIVERED IN <br /> Orange County Health Dept ACCORDANCE WITH THE POLICY PROVISIONS. <br /> PO Box 8181 <br /> Hillsborough,NC 27278 AUTHOR2ED REP RESMA <br /> Patton,Morgan& ark <br /> ACORD 25(201&03) ©198�AAC�ORD <br /> D CORPORATION. All rights re rVed. <br /> The ACORD name and logo are registered marks O <br />